- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,454.71 / $6,606.93
| Facility | | $758.58 | $2,454.71 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,737.80 / $2,818.38
| Facility | | $1,122.02 | $1,737.80 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $891.25 / $3,890.45
| Facility | | $524.81 | $891.25 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,230.27 / $3,162.28 / $3,162.28
| Facility | 54 | $1,230.27 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $707.95 / $2,511.89
| Facility | | $154.88 | $707.95 | $2,511.89 |